Individual
JEFFREY GAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
180 KENNEDY MEMORIAL DR, SUITE 101, WATERVILLE, ME 04901-4540
(207) 861-7874
(207) 861-4646
Mailing address
180 KENNEDY MEMORIAL DR, SUITE 101, WATERVILLE, ME 04901-4540
(207) 861-7874
(207) 861-4646
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA001156
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA001156
STATE LICENSE #
ME
Enumeration date
03/03/2009
Last updated
03/03/2009
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